Article Text

Download PDFPDF
Original research
Impact of smoking on the development of idiopathic pulmonary fibrosis: results from a nationwide population-based cohort study


Background Smoking has been considered an important risk factor for idiopathic pulmonary fibrosis (IPF) incidence. However, there are no population-based large-scale studies demonstrating the effects of smoking on the development of IPF. We aimed to evaluate the effect of smoking on IPF development using a nationwide population-based cohort.

Methods Using the Korean National Health Information Database, we enrolled individuals who had participated in the health check-up service between 2009 and 2012. Participants having a prior diagnosis of IPF were excluded. The history of smoking status and quantity was collected by a questionnaire. We identified all cases of incident IPF through 2016 on the basis of ICD-10 codes for IPF and medical claims. Cox proportional hazards models were used to calculate the adjusted HR (aHR) of the development of IPF.

Results A total of 25 113 individuals (0.11%) with incident IPF were identified out of 23 242 836 participants registered in the database. The risk of IPF was significantly higher in current and former smokers than in never smokers, with an aHR of 1.66 (95% CI 1.61 to 1.72) and 1.42 (95% CI 1.37 to 1.48), respectively. Current smokers had a higher risk of IPF than former smokers (aHR 1.17, 95% CI 1.13 to 1.21). The risk of IPF development increased as the smoking intensity and duration increased.

Conclusion Smoking significantly increased the risk of IPF development. Current smokers had a higher risk of IPF than former smokers. A dose–response relationship was observed between smoking and the development of IPF.

  • idiopathic pulmonary fibrosis
  • clinical epidemiology
  • tobacco and the lung

Data availability statement

No data are available. The data that support the findings of this study are available from the National Health Insurance Service in Korea but restrictions apply to the availability of these, which were used under license for the current study, and so are not publicly available.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Airwaves
    The Triumvirate